Provider Demographics
NPI:1659942076
Name:HOLCOMB, ANNA MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 N COUNTY ROAD 900 W
Mailing Address - Street 2:
Mailing Address - City:ROYAL CENTER
Mailing Address - State:IN
Mailing Address - Zip Code:46978-9699
Mailing Address - Country:US
Mailing Address - Phone:574-702-3238
Mailing Address - Fax:
Practice Address - Street 1:719 SPENCER ST STE 100
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-3584
Practice Address - Country:US
Practice Address - Phone:574-732-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-107691106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician